Fillable UNCLAIMED MONIES REFUND REQUEST (Australian National University)

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UNCLAIMED MONIES REFUND REQUEST (Australian National University)

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UNCLAIMED MONIES REFUND REQUEST
Page 1Australia and New Zealand Banking Group Limited (ANZ) ABN 11 005 357 522.
SECTION 1. CLAIMANT DETAILS
Claimant Full Name(s)
Claimant(s) current residential/business address Suburb State Postcode
Claimant(s) landline number Claimant(s) mobile number* Claimant(s) email address*
*Updates regarding your claim may be sent directly to your mobile or email address provided.
SECTION 2. UNCLAIMED MONEY DETAILS
Please confirm that you have Unclaimed Monies that we can assist with by checking the publicly available ASIC register at www.moneysmart.gov.au
Full Name of Unclaimed Monies Account
Address listed for Unclaimed Monies Account Suburb State Postcode
OTN Reference as listed on ASIC Unclaimed Monies Amount
SECTION 3. VERIFYING YOUR ACCOUNT OWNERSHIP
Note: Certification of documents can be done at your local branch or by an Authorised Certifier
Attach certified copy of document showing proof of account ownership relating to account transferred as unclaimed (e.g. bank statement)
Attach evidence to connect you to the address listed on the ASIC record (e.g. Council rates notice, Utilities bill)
For company claims only*
Attach proof of current association and proof of current Directors/Partners/Authorised Signatories of Company/Inc.
*If the company is deregistered, please contact ASIC directly. Details can be located on www.asic.gov.au
SECTION 4. VERIFYING IDENTITY OF CLAIMANT(S)
Attach two certified copies of identification for the account holder; one of which includes a photo, signature, date of birth and current address
(e.g. Drivers Licence or Passport)
*
For authorised representatives, in addition to the above, please provide your identification and authorising document (e.g. certified copy of Power of Attorney)
SECTION 5. DECEASED ESTATES CLAIMS
The executor or administrator of the estate can claim by providing all of the above documentation, in addition to the following:
Certified copy of Death Certificate, certified copy of Will, Identification of executor(s) and Indemnity Form
OR
Certified copy of Probate or Letters of Administration and identification of Administrator(s) or Executor(s)
UNCLAIMED MONIES REFUND REQUEST
Page 2Australia and New Zealand Banking Group Limited (ANZ) ABN 11 005 357 522. Item No. 84237 09.2017 W583763
SECTION 6. REFUND DETAILS
BSB Account Number Bank/Financial Institution
Account Name
International Transfers
For refunds to an overseas banking institution, please complete the International Money Transfer Form located on anz.com and forward
together with the Claim form.
*Note: this service may incur fees and charges
*Note: If payment refund instructions are invalid, ANZ may return funds to ASIC
SECTION 7. DECLARATION AND SIGNATORIES
Declaration
This is to certify that the Claimant(s) named above is/are the rightful owner(s) of money remitted to the Australian Securities and Investments Commission
(ASIC) in compliance with the Banking Act.
• I/ We had an Account/Card with ANZ of which I/we believe that the money has been transferred to ASIC
• The Account/card details were correct as stated above
• I/We are the true owner(s) of the money in the Account/Card and am/are entitled to claim the money that were available in the Account/Card
immediately prior to the value being transferred and the Account/Card being closed by ANZ
• I/We request ANZ to act on our behalf for the recovery of the balance of the Account/Card and request the ASIC to pay the proceeds to ANZ
• Any previous appointment of an Agent to act on my/our behalf in this matter, and any direction or authority by me/us to pay the proceeds
to the Agent, is hereby revoked
• I/We have notified or will promptly notify the Agent of the revocation of the authority
• I acknowledge refunds from the Australian Securities and Investments Commission (ASIC) can take up to 28 days
• I am aware that I am responsible for the correctness of the information provided.
Note: It is an offence under the Anti-Money Laundering and Counter-Terrorism Financing Act 2006 to give false or misleading information or documents.
All signatories (or Executors)
Full Name Full Name
Signature Signature
Date (DD/MM/YYYY) Date (DD/MM/YYYY)
Send completed form with attachments to : Customer Resolution
Unclaimed Monies
5A/833 Collins Street
Docklands VIC 3008
ANZ is collecting your personal information to enable it to assess your application and if successful, will be used to arrange for a refund of unclaimed money. Without this
information we may not be able to consider or approve your application. If the unclaimed money is held by a government body (i.e. ASIC), ANZ will disclose the collected
information to the government body to process the claim. ANZ may disclose information to recipients located offshore. Information about the location of such recipients is
contained in ANZ’s Privacy Policy ( www.anz.com/privacy ).
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UNCLAIMED MONIES REFUND REQUEST (Australian National University)

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Completed 5 July 2022

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